Case study: Gary’s story

Gary has decided, with the help of his family and staff at Richardson Care, to tell the story of how his life has changed since his brain injury. He gives us some insight into the rehabilitation process, and what seemingly small things can do to initiate the construction of continuing improvement and fulfilment.



At the age of 40, Gary was the pedestrian victim of a hit and run accident and sustained a serious traumatic brain injury. After five months in hospital, he was transferred to a specialist medical unit, where he stayed for three years. He was moved to a rehabilitation unit, then to another one a year later. In 2009, six and a half years after the accident, he came to Richardson Care, where he has been for ten years.

Before the accident, Gary was very outgoing and had a good sense of humour. On admission to Richardson Care, very basic interaction was extremely distressing for Gary. Coming to terms with his new environment, compounded by the constraints that short term memory loss affords, meant that even coming out of his room was a challenge. The care team devised a plan to encourage and promote more activity. They discovered that Gary enjoyed a drive in the country and this raised the possibility of outings. Very gradually, a stop was introduced, then a coffee, then lunch. Then the drive was not just a country drive, as the focus was lunch or coffee. Then this became an activity, and gradually Gary was able to participate in other activities, such as going to a Headway group.

Social interaction

The fear of social interaction was looked at in a similar way. Initially Gary would spend ten minutes in a communal area and gradually this was built up to having a cup of coffee, then lunch, and by 2014 this had turned into him engaging in an activity and asking to remove himself when he became tired and wanted normal time out. In 2016, Gary enjoys mixing with other people and experiencing the wider community.

The combination of these two techniques has resulted in Gary now being able to go on communal activities such as a Headway group or an in-house activity, or joining a group of friends on a meal out. This process has

only been possible by the combination of psychologists understanding his emotional and cognitive state and the staff using this information to construct a sensitive intervention, with their understanding of what this means on a practical level.

Multi-disciplinary approach

Psychological support runs in conjunction with Speech & Language Therapy, which has enabled Gary to improve his communication skills and manage his dysphagia, both contributing to more effective interaction and greater enjoyment of the social aspects of eating out.
Physiotherapy has helped Gary to increase his strength. Occupational Therapy has also enabled Gary to increase his skills in a range of areas, contributing to an improvement in many aspects of his life.

Outcome

The outcome for Gary is life changing – the difference between being able to share an everyday experience, like having a cup of coffee, compared with wanting to be by yourself all the time and distressed, should not be understated.

Below are snapshots of different elements of Gary’s life, which have combined to enable him to be the person he is today. They demonstrate that the right environment and a combination of therapies (including neuro psychology, neuro psychiatry, occupational therapy, physiotherapy and speech and language therapy) consistently applied, can still dramatically improve the quality of someone’s life, even several years after sustaining an injury and many years of rehabilitation.

In addition, reducing incidents of anxiety, aggression and challenging behaviour, reduces risks to the individual, fellow service users and staff and requires less intensive supervision.



Garys improvements
Garys improvements2

Social skills and supervision rating

The chart below shows the significant improvement in Gary’s social skills, which not only improves the quality of his life, it means that he is more independent and requires less supervision. The chart shows the level of supervision required according to our standard supervision rating scale.

Scores range between 0, where there is no special problem or supervision required, and 3,

where complete supervision is required.

Areas Assessed

Fee reduction

The reduction in supervision required means that Gary needs less intensive care 24 hours a day. This has been countered to some extent as Gary now participates in more activities, which require two support workers. However, we have managed to achieve a real-term reduction in fees for Gary’s care and rehabilitation.

Incidents of verbal or physical aggression

Gary’s increased confidence and cognition, the trust he shows in his support staff and his willingness to engage have all contributed to a reduction in aggressive or challenging behaviour. Three one-month periods were selected at random in 2009, 2012 and 2016 and the number of incidents of aggression was counted. These are shown on the graphs below. Although no incidents of physical aggression occurred in the month recorded in 2016, it doesn’t mean that this behaviour has completely stopped.

Verbal Aggression

Gary’s care and support at The Richardson Partnership for Care is a fine example of how the right care and intervention can lead to sustained improvement in the quality of life for someone with a serious traumatic brain injury, even several years after they have sustained the injury and received initial treatment.



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